The decision on whether or when to treat patients with CLL depends on many factors, including the stage of disease. Because CLL is not curable and because it generally occurs in older people without symptoms and often progresses slowly, it is usually treated in a conservative fashion.
Standard Treatment In the early stages, most patients do not require any treatment. In a typical case, the white blood cell count is very high but there are no symptoms. Management ranges from periodic observation by the physician (with treatment of infection, bleeding or immunologic complications as they occur) to standard chemotherapy .
In moderate to advanced disease—RAI intermediate and high-risk or International B and C—observation without treatment may still be the plan if there are no symptoms and the CLL does not progress.
If therapy is indicated because of symptoms or signs—enlarging lymph nodes or spleen or adversely changing blood counts—the conventional treatment is chemotherapy with medications taken by mouth such as Leukeran and Cytoxan , singly or in combination with a steroid preparation like prednisone .
On uncommon occasions when there is one single site of lymph node enlargement, radiation to the site is appropriate. The use of total (generalized) lymph node irradiation for CLL is no longer used as conventional treatment.
